Zucchelli Giulio, Barletta Valentina, Bongiorni Maria G
Cardiac Thoracic and Vascular Department, AOUP, Santa Chiara University Hospital, Pisa, Italy -
Cardiac Thoracic and Vascular Department, AOUP, Santa Chiara University Hospital, Pisa, Italy.
Minerva Cardioangiol. 2018 Feb;66(1):113-123. doi: 10.23736/S0026-4725.17.04465-6. Epub 2017 Jul 10.
Leadless pacemaker (LP) technology was recently developed and introduced for clinical purpose as an alternative to traditional systems in order to reduce leads and pocket-related complications. Currently, two self-contained right ventricular pacemakers implanted by using a femoral percutaneous approach have been developed and initial results seem promising. Although the clinical use is still limited to the right ventricular pacing, the LP currently represents a valid and alternative solution in several settings, when the standard pacemaker cannot be used or its use is associated with higher risk of complications. Implementation of particular pacing algorithms in the near future will allow for a VDD pacing mode with only a single ventricular component, whereas the next evolution of technology will lead to develop multicomponent, communicating leadless systems capable to perform a dual-chamber pacing or even a cardiac resynchronization. The management after battery depletion is still controversial and experience on retrievability is anecdotic. Long term data from registry are necessary to reinforce the reliability of these systems in the real life and randomized trials comparing LPs with traditional pacemaker will be essential to better understand if the LP can become a new paradigm in cardiac pacing.
无导线起搏器（LP）技术是最近为临床目的而开发并引入的，作为传统系统的替代方案，以减少与导线和囊袋相关的并发症。目前，已经开发出两种通过股动脉经皮途径植入的独立右心室起搏器，初步结果似乎很有前景。尽管临床应用仍局限于右心室起搏，但在标准起搏器无法使用或使用标准起搏器会带来更高并发症风险的几种情况下，无导线起搏器目前是一种有效的替代解决方案。在不久的将来，特定起搏算法的应用将实现仅具有单个心室组件的VDD起搏模式，而技术的进一步发展将促使开发能够进行双腔起搏甚至心脏再同步治疗的多组件、可通信的无导线系统。电池耗尽后的管理仍存在争议，关于可回收性的经验也只是传闻。来自注册研究的长期数据对于增强这些系统在现实生活中的可靠性至关重要，比较无导线起搏器与传统起搏器的随机试验对于更好地理解无导线起搏器是否能成为心脏起搏的新范例至关重要。
